Surgical patients see better outcomes but face longer hospital stays, AHA and Vizient report finds

Editor's Note

Hospitalized surgical patients in 2024 were nearly 20% more likely to survive than expected compared to 2019, according to an August 5 analysis from the American Hospital Association (AHA) and Vizient. The report credits safety improvements such as reductions in infections, falls, and major complications, even as surgical patients admitted to hospitals are presenting with greater acuity and staying longer.

The analysis showed sharp declines in three high-risk postoperative complications closely tied to mortality: hemorrhage (down 22.3%), sepsis (down 9.2%), and respiratory failure (down 19%). In addition, vascular catheter-related infections, urinary tract infections, and patient falls all decreased compared to pre-pandemic levels. These safety gains align with earlier findings from AHA and Vizient showing that hospitals’ quality initiatives helped an estimated 200,000 patients survive hospitalizations between April 2023 and March 2024 who might not have in 2019.

Despite these improvements, the report found the average length of stay for hospitalized surgical patients has risen by almost 1 day over the past 5 years. Rising patient acuity is one factor, but delays in post-acute care placement—often tied to Medicare Advantage plans’ prior authorization requirements and coverage denials—also play a significant role. Among Medicare Advantage patients, hospital stays prior to post-acute transfer have doubled compared with traditional Medicare since 2019.

The shift of lower-acuity procedures to outpatient settings is reshaping the inpatient surgical population. Hospitals are increasingly caring for patients with more complex needs, and Vizient projects this trend will intensify over the next decade. By 2035, hospital days for the sickest surgical patients, often called “quaternary,” are expected to grow by nearly 20%.

AHA President and CEO Rick Pollack said the results highlight hospitals’ resilience and commitment to advancing safety, while Vizient’s Chief Medical Officer David Levine, MD, pointed to the role of analytics and technology-driven insights in improving outcomes. Both emphasized that hospitals must continue to adapt as acuity rises and payer practices strain discharge processes.